Dementia in Prison Is Turning into an Epidemic: The U.S. Penal System Is Badly Unprepared (2022)

Terrell Carter remembers one prisoner in particular. They had both been seeking commutations of their life sentence so they could eventually apply for parole. But Carter says that in the midst of the process, his fellow inmate became so debilitated with dementia that the man could no longer function well enough to complete the paperwork.

Within a few months, Carter says, this prisoner was incapacitated, lying in bed with arms outstretched over his head, calling for help. Carter, an inmate who volunteered in the hospice ward of State Correctional Institution Phoenix in Collegeville, Penn., says that his fellow prisoner languished and eventually perished in prison because he was too mentally impaired to file for forgiveness. “By the end, he didn’t know the crime he was charged with committing,” Carter says

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In the October 2021 issue of Northwestern University Law Review, Carter, along with Drexel University associate professor of law Rachel López, argues that the current sentencing structure all too often locks people up and throws away the key. A former commissioner on Pennsylvania’s sentencing board, López is especially concerned with the number of elderly people who are incarcerated. “It’s all part of the legacy of the ‘tough on crime’ era,” she says.

A survey by the Pew Charitable Trusts found that the number of inmates age 55 or older increased by 280 percent from 1999 to 2016. Three-strikes laws and mandatory life sentences without the possibility of parole expanded during the 1980s and 1990s, and many of these laws are still on the books today. As the number of aging prisoners balloons, so, too, do instances of dementia. An article López authored in the June 2020 issue of Federal Sentencing Reporter projected that between 70,341 and 211,020 of the estimated 400,000 incarcerated elderly in 2030 will develop dementia. Alzheimer’s disease is the most common diagnosis, but dementias that involve Lewy bodies, the vascular system and Parkinson’s disease are also on the list.

Prison may also accelerate aging and the possibility of developing the disease, according to a January 2022 article published in the journal Health & Justice. Study author Bryce Stoliker, a researcher at the University of Saskatchewan, says that the high risk is because of challenges faced in prison life—and inmates’ experiences before incarceration. Prisoners are often marginalized members of society with less access to health care, poorer diet, issues with alcohol or drug misuse, mental health problems and potential traumatic brain injuries—all factors that increase the likelihood of developing the condition. “Once behind bars, a lack of stimulation and an overall poor quality of life magnifies the problem,” Stoliker says.

Prisoners with dementia are also vulnerable to abuse. Their erratic behavior and inability to follow directions is aggravating to other prisoners and to the staff in an already tense and sometimes violent environment, says Tina Maschi,co-author of the book Aging Behind Prison Walls: Studies in Trauma and Resilience.

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A 2012 study she authored in the Gerontologist found that those with dementia are increasingly vulnerable to “victimization.” If they become aggressive toward staff or can’t stay in line, they’re more likely to be reprimanded. “They’re no longer in touch with the prison rules, and as a result, it appears to staff, who often aren’t trained in dealing with dementia patients, that they’re acting out,” Maschi says. Additionally, according to the study, they can become victims of sexual assault by other prisoners because they can’t defend themselves.

With strict sentencing practices still in place, the problem could get worse. The American Civil Liberties Union projects that in a decade, prisoners age 55 and older will make upone third of the U.S. incarcerated population. And prisons, López says, don’t have the resources to tend to this highly vulnerable population. Still, there may be some relatively available short-term solutions. Older prisoners are often housed together, but senior structured living programs that include daily stimulation such as puzzles, knitting and cognitive exercises may help to reduce the risk of elderly prisoners who get dementia later on.

True Grit, a program at Northern Nevada Correctional Center, is described in a review published in the December 2019 issue of Health & Justice. It teaches inmates older than age 55 skills such as latch rug making, crocheting, painting, jigsaw puzzle making and beading, as well as emphasizing the importance of physical exercise. The program has been shown to increase inmate quality of life, reduce medication use and behavioral problems, and enhance overall health and well-being.

Compassionate release is another tool that is largely underutilized, according to experts. Also called “geriatric parole,” it’s currently used once patients get to the end of their life. But for the program to reduce the elderly burden on the prison system, it would have to be used before inmates are so ill that they can no longer be integrated back into society. Once prisoners are too far gone, says Ronald Aday, author of the book Aging Prisoners: Crisis in American Corrections, it’s much harder for them to find “a place to land” outside of prison, and nursing homes are unlikely to admit a felon. Still, a 2018 report from Families Against Mandatory Minimums (FAMM) found that the program is rarely used and that, in many states, it presents aging inmates with a troubling “number of barriers” to getting out.

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When inmates do develop dementia, prison workers, at a minimum, need to be provided with basic training to deal with the disease. “Correctional staff and those in direct daily contact with older prisoners need to understand both their vulnerability to other inmates and their inability to understand orders,” Aday says.

Looking ahead, dementia wards in prison may be needed to house prisoners with cognitive problems. One such memory ward opened in 2019 at Federal Medical Center Devens in Massachusetts. The facility staff is specially trained to take care of those with dementia.

But building dementia wards in prisons shines a spotlight on a larger issue: prisons are not properly equipped to house these patients because this was never their purpose in the first place. “The original intent of prison was to rehabilitate,” Aday says. “Correctional institutes were meant to ‘correct people’ so they could go back out and work.” Somewhere along the way, he adds, we’ve lost our purpose, and as a result, 10-year sentences have tripled, and life in prison without the possibility of parole is all too common. If we don’t get ahold of our out-of-balance sentencing structure, Aday says, we’ll never be able to really address the issue.

Carter, now age 53, feels lucky that he made it out “by the skin of his teeth.” After graduating from Villanova University and spending years taking care of elderly inmates, he was able to commute his sentence to life with parole for a robbery that he says went terribly wrong when he was 22 years old. Last July he was released after spending three decades in maximum-security prison.

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Still, Carter is haunted by those he left behind, especially in the hospice ward. He says by the end of their life, most of them don’t even realize where they are, let alone what got them there. “You gotta wonder what kind of punishment it is if you don’t even know you’re in prison,” Carter says.


    Sara Novak is a science writer based on Sullivan's Island, South Carolina. Her work has appeared in Discover, Sierra Magazine, Popular Science, New Scientist, and more.Follow Sara Novak on Twitter

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    What happens to prisoners if they get dementia? ›

    Receiving a diagnosis

    This means that prisoners' dementia can go undiagnosed, leaving them without support in an environment that can be hostile to their needs. Whilst most prisons are required to conduct health screenings, they do not typically look for issues related to aging or cognitive decline.

    What are the most common problems in prison? ›

    Incarcerated People Living with Mental Health Conditions

    Some common conditions include depression, anxiety disorders, schizophrenia and bipolar disorder. Recent research by the Bureau of Justice Statistics shows that more than half of all people in prison have mental health issues.

    What are the most common causes factors of prison violence? ›

    Factors such as gang rivalries, overcrowding, minor disputes, and prison design contribute to violent attacks. Prisons are trying to avoid, or at least better deal with these situations by being proactive.

    What are challenges that older inmates with dementia experience? ›

    Elderly prisoners with dementia are also at an increased risk of victimization, sexual assault and bullying from other prisoners. Additionally, because they struggle to understand and follow prison rules, they are also more likely to be subjected to harsh punishment while incarcerated.

    Can someone with dementia commit a crime? ›

    Share: Persons living with dementia commit acts that would be crimes if the person was able to form intent and understand their actions, and the aging of the prison population is leading to unprecedented numbers of persons behind bars developing dementia.

    What are the 3 biggest problems with the US prison system? ›

    Our prison system has many problems and is in desperate need of reform. Some of these problems include inhumane living conditions, racial bias, and increased risk of reincarceration.

    What are the main challenges facing the penal system? ›

    Notably, the report states, “stakeholders are concerned that it could take years to clear the backlog that has now accumulated”.
    • Prison places threatened. ...
    • Increased demand. ...
    • Funding uncertainty. ...
    • Prisoner mental health.

    What harm does the prison system cause? ›

    The main types of harm which prisons are said to cause are harm to physical and mental health, psychological stress, increased likelihood of recidivism, negative attitudes toward authority as a result of unfair handling of grievances, and problems with families.

    What is the number one cause of death in prison? ›

    Suicides are the leading cause of jail deaths. Fatal drug overdoses are the fastest growing cause of death.

    What are three major issues that prisons are facing today? ›

    Millions of Americans are incarcerated in overcrowded, violent, and inhumane jails and prisons that do not provide treatment, education, or rehabilitation. EJI is fighting for reforms that protect incarcerated people.

    What are 3 reasons we have mass incarceration in the US? ›

    Although the war on drugs had sparked the significant incline of mass incarceration, there are three factors that sustain its impact: 1) over-policing in redlined and marginalized communities, 2) longer sentencing for minor crimes, and 3) endless restrictions after being released.

    What happens when prisoners get too old? ›

    Aging behind bars is not on anyone's bucket list, but crime and punishment do not have an age limit for elderly inmates. An early release is an option in some cases, but an elderly prisoner's early release can be a long and tedious process.

    What happens when a dementia patient becomes violent? ›

    Aggression may be a symptom of Alzheimer's disease itself. It could also be a reaction when a person feels confused or frustrated. If your loved one becomes aggressive, it's important to remember that they aren't doing it on purpose.

    What are the most common problems experienced by people with dementia? ›

    Why Seniors with Dementia or Alzheimer's Disease Require Specialized Care
    • General loss of memory and cognitive thinking.
    • Changes (sometimes sudden) in mood and/or behavior.
    • Disorientation and general confusion.
    • Loss of ability to speak or hold conversations.
    • Difficulty walking or swallowing.

    Is it OK to lie to someone with dementia? ›

    Lying to someone who has dementia may be justified when it's necessary to promote wellbeing or prevent harm. Medical ethicists call this beneficence and non-maleficence. Beneficence involves the act of “doing good.” Non-maleficence, on the other hand, means to “do no harm.”

    Do people get meaner with dementia? ›

    Sometimes, dementia can provoke so much aggression and anger that the person and those around them are no longer safe. If this happens, it's time to call a doctor. Medication should never be the first choice in dealing with challenging behaviors.

    Do people with dementia start stealing? ›

    Pathological stealing can be a prominent feature of neurological disorders that involve the frontal lobes. The most common cause of pathological stealing appears to be FTD, a common dementia in the presenium characterized by disinhibition, inertia, lack of empathy, compulsive behaviors, and eating disorders.

    How can the US prison system be improved? ›

    The most obvious example for an integrated strategy is the combination of legislative and practical measures to reduce imprisonment rates and overcrowding in prisons, with training and capacity building in prison management to improve conditions and services in prisons.

    What are the 3 biggest challenges that inmates face when returning back to the community? ›

    The 4 Biggest Challenges Facing Those Newly Released From Prison
    • Challenge #1: Not Knowing Where to Begin.
    • Challenge #2: Family Strain.
    • Challenge #3: Finding Employment.
    • Challenge #4: Mental Health Issues.

    Is the prison system effective? ›

    Sending an individual convicted of a crime to prison isn't a very effective way to deter crime.” Prison is an important option for incapacitating and punishing those who commit crimes, but the data show long prison sentences do little to deter people from committing future crimes.

    How does mental health affect the criminal justice system? ›

    According to a report from the Bureau of Justice Statistics (BJS), more than half of those incarcerated in the United States have mental health issues. These individuals, says BJS, are more likely to have previous convictions and to serve a lengthier sentence than those who do not have mental health needs.

    What are the two most important goals of the penal system? ›

    Crime control: Incapacitation and deterrence

    The concept of incapacitation is simple—as long as offenders are incarcerated, they cannot commit crimes outside of prison.

    What is the purpose of the penal system? ›

    First, protection of the public – prison protects the public from the most dangerous and violent individuals. Second, punishment – prison deprives offenders of their liberty and certain freedoms enjoyed by the rest of society and acts as a deterrent.

    Does prison cause mental health problems? ›

    And some individuals who were considered mentally healthy prior to their arrest develop mental health symptoms once they are in prison. Being in prison can take a serious toll on an individual's psychological well-being. New conditions often develop, and pre-existing conditions may worsen.

    Why do prisons do more harm than good? ›

    They would argue that prison further damages people because it causes further trauma, exposes them to further violence, reinforces disadvantage and creates further crime and social harm. The prison also does very little to tackle the underlying causes of crime in communities.

    Why does prison make criminals worse? ›

    Prison have long been described as "schools for crime" or "breeding grounds for crime." The central idea is that incarcerating offenders makes them worse because they learn new "tricks of the trade." There is an inevitability to the perception that if you land in prison, you will turn into an even more corrupt or ...

    What's the difference between jail and prison? ›

    Jail and prison are two separate entities that are often mixed up. The difference between jail and prison is mostly the length of stay for inmates. Jail is more for a short-term sentence, while prison is for those with a long-term sentence.

    What disease is common in prison? ›

    Brunette notes that the treatment for hepatitis with interferon can lead to depression and that people with mental illness may be less able to cope with side-effects such as fatigue (2). Incoming prisoners are at higher risk of HIV, viral hepatitis, STIs, TB and methicillin-resistant Staphylococcus aureus (3).

    Who was the killer in the prisoners? ›

    Holly Jones is the main antagonist of the 2013 thriller film Prisoners. She was portrayed by Melissa Leo, who also played Sally in Oblivion.

    What are the most serious issues associated with healthcare in prisons? ›

    Infectious disease is more prevalent among incarcerated populations than in the general population. Compared to the general population, individuals living in correctional facilities are approximately three times more likely to have HIV or AIDS17 and are more likely to have hepatitis C18 and tuberculosis.

    What do prisoners do all day? ›

    Inmates wake up at 5:30 AM and have 45 minutes to shower, clean up and make their bed. They go to the dining hall and eat breakfast in shifts beginning at 6:15. The inmates assemble for the count, search and assignment to the road squads at 8 AM and over the next 30 minutes travel to their worksite.

    What is the main reason for mass incarceration? ›

    Drug offenses still account for the incarceration of almost 400,000 people, and drug convictions remain a defining feature of the federal prison system. Police still make over 1 million drug possession arrests each year, many of which lead to prison sentences.

    What is the biggest cause of mass incarceration? ›

    Since the 1970s, the incarcerated population in the United States has skyrocketed by 500%, leading to more than 2 million people behind bars. The rise in mass incarceration nowadays can be attributed to a number of factors, including an increase in drug-related offenses and stricter sentencing laws.

    Why is mass incarceration a problem in the US? ›

    Mass incarceration rips apart families and communities, disproportionately hurts people of color, and costs taxpayers $260 billion a year. At the same time, crime continues to drop to 30-year lows — and harsh punishments aren't the reason.

    What happens to dementia patients who are violent? ›

    Aggressive behaviour in dementia

    In the later stages of dementia, some people with dementia will develop what's known as behavioural and psychological symptoms of dementia (BPSD). The symptoms of BPSD can include: increased agitation. aggression (shouting or screaming, verbal abuse, and sometimes physical abuse)

    Are people with dementia institutionalized? ›

    People with dementia had a seven times higher hazard to be institutionalized than controls (HR 7.3, 95% CI 6.9, 7.7; P < 0.001) (Figure 2).

    What happens when a dementia patient gets sectioned? ›

    Being Sectioned means the person is effectively detained, either in hospital or in another kind of care facility (including a care home) for everyone's safety. The person will be detained under Section 3 of the Mental Health Act, and the care they need (known as aftercare) relates to Section 117 of the same Act.

    Can a 75 year old go to jail? ›

    There is no rule on suspension of sentence by reason of seniority. There are some views that an accused, who is over 70 years of age, is entitled to post bail even though the crime is non-bailable for being punishable by reclusion perpetua because of the case of Enrile.

    What is the longest time a person has been in jail? ›

    In 1981, in Tuscaloosa, Alabama, USA, Dudley Wayne Kyzer received the longest single sentence of 10,000 years for murdering his wife. He then received a further two life sentences for murdering his mother-in-law and a college student.

    What happens to your brain when you go to jail? ›

    Many other incarcerated individuals may experience depressive disorders, anxiety disorders, or PTSD. 5 For some, these issues may be pre-existing conditions. For others, the issues may have started after their incarcerations. Quite often, disorders go unrecognized by people in prison and prison staff.

    Why do dementia patients get so angry? ›

    According to Visiting Angels, “Confusion is one of the leading causes of anger and aggression in Alzheimer's and dementia sufferers. Confusion can be triggered by lost trains of thought, mixed up memories, or a sudden change in the environment, such as a change from one caregiver to another.”

    Can people with dementia control their anger? ›

    On top of that, a person with dementia has lost the ability to control their mood (or self-soothe). Because of this, once they are angry, they will have a hard time letting that bad feeling go.

    Should a person with dementia attend a funeral? ›

    Taking a person with Alzheimer's disease to the funeral of a loved one is an individual choice based on behavior and cultural preferences, but can sometimes help the individual process the loss.

    How long does a person live with dementia? ›

    The average life expectancy figures for the most common types of dementia are as follows: Alzheimer's disease – around eight to 10 years. Life expectancy is less if the person is diagnosed in their 80s or 90s. A few people with Alzheimer's live for longer, sometimes for 15 or even 20 years.

    What is the most common cause of death in dementia patients? ›

    One of the most common causes of death for people with dementia is pneumonia caused by an infection. A person in the later stages of dementia may have symptoms that suggest that they are close to death, but can sometimes live with these symptoms for many months.

    Do dementia patients get mean? ›

    Dementia behavior: Aggression. Verbal threats and physical aggression can be among the more serious of the dementia behaviors. These verbal or physical outbursts may occur seemingly out of nowhere. They tend to happen in the latter stage of dementia, when patients can't communicate their needs.

    How do hospitals calm dementia patients? ›

    Bring comfort objects.

    Things like photographs, a favorite blanket, a stuffed animal or even a small toy can help a person with dementia feel more at ease in an unfamiliar situation.

    Is dementia a disability? ›

    The specific symptoms that someone experiences will depend on the parts of their brain that are damaged and the underlying cause of their dementia. The cognitive and physical impairments caused by dementia are recognised as a disability both under domestic law5 and international convention6.


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